Individual provider · NPI-1

Maya Brianna Bolak

Behavior Technician · Eagle River, AK

NPI number1982187092
StatusActive
Last updated in NPPESSep 13, 2018

Details

NPI
1982187092
Entity type
Individual (NPI-1)
Name
Maya Brianna Bolak
Sex
Female
Sole proprietor
No
Enumeration date
Sep 13, 2018
Last updated
Sep 13, 2018

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
106S00000X Behavior Technician––Yes

Practice location

16941 N Eagle River Loop Rd
Eagle River, AK 99577-7824

Phone 907-726-5330

Mailing address

24550 Park Dr
Chugiak, AK 99567-6225

Phone 907-406-7430

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